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BiCNU Side Effects

Generic Name: carmustine

Note: This page contains information about the side effects of carmustine. Some of the dosage forms included on this document may not apply to the brand name BiCNU.

For the Consumer

Applies to carmustine: implantation implant

In addition to its needed effects, some unwanted effects may be caused by carmustine (the active ingredient contained in BiCNU). In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking carmustine, check with your doctor or nurse immediately:

More common:
  • Blurred vision
  • change in ability to see colors, especially blue or yellow
  • confusion
  • fever
  • headache
  • nausea and vomiting
  • problems with movement, walking, or speech
  • seizures
  • trouble healing
Less common:
  • Drowsiness
  • general feeling of illness
  • severe headache
  • stiff neck or back

Minor Side Effects

Some of the side effects that can occur with carmustine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Abdominal or stomach pain
  • back pain
  • bladder pain
  • bloody or cloudy urine
  • difficult, burning, or painful urination
  • difficulty having a bowel movement (stool)
  • discouragement
  • feeling sad or empty
  • frequent urge to urinate
  • irritability
  • lack of appetite
  • lack or loss of strength
  • loss of interest or pleasure
  • lower back or side pain
  • tiredness
  • trouble concentrating
  • trouble sleeping
Less common:
  • Chest pain

For Healthcare Professionals

Applies to carmustine: implant device, intravenous powder for injection


Most of the patients with respiratory toxicity received prolonged therapy with total doses greater than 1400 mg/m2, although respiratory problems have been reported in patients receiving as little as 600 mg/m2.

Delayed onset pulmonary fibrosis occurring up to 17 years after treatment has been reported in one long-term study (n=17) on patients who received carmustine (the active ingredient contained in BiCNU) in childhood and early adolescence combined with cranial radiotherapy (for intracranial tumors). Chest X-rays revealed pulmonary hypoplasia with upper zone contraction. Thoracic CT scans showed an unusual pattern of upper zone fibrosis. Some late reduction of pulmonary function was reported in all long-term survivors. In this long-term study, 8 of 17 died of delayed pulmonary lung fibrosis, including all those initially treated (5 of 17) at less than 5 years old.[Ref]

Respiratory side effects including pulmonary infiltrates and/or fibrosis have been reported to occur from 9 days to 43 months after treatment with carmustine and related nitrosoureas. Cases of fatal respiratory toxicity have been reported.[Ref]


Carmustine may produce cumulative myelosuppression. Thrombocytopenia has generally been reported to occur approximately four weeks after administration. Leukopenia has generally been reported to occur approximately five to six weeks after administration. Both have been reported to persist for one to two weeks.

Use of carmustine (the active ingredient contained in BiCNU) in combination with cimetidine has resulted in greater myelotoxicity (e.g., leucopenia, neutropenia).[Ref]

Hematologic side effects including myelosuppression have been reported frequently. Thrombocytopenia, leukopenia, and less frequently, anemia have also been reported. Acute leukemia and bone marrow dysplasias have been reported following long-term nitrosourea therapy.[Ref]


Nausea and vomiting generally appear within two hours of dosing and last for four to six hours. Prior administration of antiemetics has been effective in diminishing and sometimes preventing these side effects.[Ref]

Gastrointestinal side effects including nausea and vomiting have been reported frequently.[Ref]


Hepatic side effects including increased transaminase, alkaline phosphatase, and bilirubin levels have been reported infrequently.[Ref]

The increased levels are generally reversible.[Ref]


Renal side effects including progressive azotemia, decrease in kidney size, and renal failure have been reported in patients after prolonged therapy and usually after large cumulative doses.[Ref]


Cardiovascular side effects including hypotension and tachycardia have been reported. Three cases of myocardial ischemia during and immediately after high-dose carmustine (the active ingredient contained in BiCNU) infusion have been reported.[Ref]


Local side effects including burning and hyperpigmentation have been reported.[Ref]


This effect usually has been reported to occur within two hours and last for approximately four hours.[Ref]

Other side effects have included intensive flushing of the skin and suffusion of the conjunctiva following rapid intravenous infusion of carmustine.[Ref]


Ocular side effects including neuroretinitis have been reported.[Ref]


General side effects including chest pain and headache have been reported.[Ref]


Oncologic side effects have included spontaneous reports of cyst formation after gliadel wafer implantation. Carcinogenicity has been reported in animal studies.[Ref]

Cyst formation occurred at varying time intervals postimplantation. Cyst formation has also been reported in patients following resection of malignant glioma who have not had gliadel implanted.

Carmustine has been reported in animal studies to produce a marked increase in tumor incidence at doses approximating clinical doses.[Ref]


1. Lena H, Desrues B, Le Coz A, Quinquenel ML, Delaval P "Severe diffuse interstitial pneumonitis induced by carmustine (BCNU)." Chest 105 (1994): 1602-3

2. "Multum Information Services, Inc. Expert Review Panel"

3. O'Driscoll BR, Kalra S, Gattamaneni HR, Woodcock AA "Late carmustine lung fibrosis. Age at treatment may influence severity and survival." Chest 107 (1995): 1355-7

4. "Product Information. BiCNU (carmustine)." Bristol-Myers Squibb, Princeton, NJ.

5. Hasleton PS, O'Driscoll BR, Lynch P, Webster A, Kalra SJ, Gattamaneini HR, Woodcock AA, Poulter LW "Late BCNU lung: a light and ultrastructural study on the delayed effect of BCNU on the lung parenchyma." J Pathol 164 (1991): 31-6

6. Kanj SS, Sharara AI, Shpall EJ, Jones RB, Peters WP "Myocardial ischemia associated with high-dose carmustine infusion." Cancer 68 (1991): 1910-2

7. Mrozek-Orlowski M, Christie J, Flamme C, Novak J "Pain associated with peripheral infusion of carmustine." Oncol Nurs Forum 18 (1991): 942

8. Wiencke JK, Wiemels J "Genotoxicity of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)." Mutat Res 339 (1995): 91-119

Not all side effects for BiCNU may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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